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Blue Cross Medicare Advantage Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Core (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Core (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Core (PPO) is a PPO plan offered by Aware Integrated, Inc. available for enrollment in 2025 to people living in 51 County Region. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Core (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Cross Medicare Advantage Core (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue Cross Medicare Advantage Core (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue Cross Medicare Advantage Core (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using standard pharmacies or preferred mail order services for up to a three-month supply. However, if you choose standard mail order for these generic tiers, you will pay a $10 copay for a one-month supply or a $20 copay for two- and three-month supplies. Tier 3 preferred brand drugs require a 25% coinsurance across standard pharmacies and mail order options. Tier 4 non-preferred drugs carry a 43% coinsurance at standard pharmacies and preferred mail order, which increases to 45% for standard mail order. Tier 5 specialty drugs are covered with a 25% coinsurance for a one-month supply through standard pharmacies and mail order services.
Additional Benefits
The Blue Cross Medicare Advantage Core (PPO) plan offers comprehensive medical coverage, featuring no copay or coinsurance for primary care visits and routine preventive care. For more intensive services, members pay a $50 copay for specialists, a $130 copay for emergency room visits, and a $465 daily copay for the first five days of an inpatient hospital stay. Outpatient services are also covered, with hospital visit copays ranging from $20 to $500. In addition to medical care, the plan provides valuable routine vision, dental, and hearing benefits to help reduce your out-of-pocket costs. Members enjoy no copays for routine eye exams, hearing exams, and dental cleanings, plus a $150 annual allowance for eyewear and up to $1,000 in yearly dental coverage. Prescription hearing aids are also accessible with copays ranging from $699 to $999.
Inpatient Hospital See details
Blue Cross Medicare Advantage Core (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $465 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. Unlimited additional acute days are covered, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Core (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $20.00 to $500.00 for outpatient hospital visits and a $500.00 copay per stay for observation services. Ambulatory surgical center services require a $400.00 copay, outpatient substance abuse sessions carry a $30.00 copay, and outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Core (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Core (PPO) covers ground and air ambulance services with a $385 copay and no coinsurance, with prior authorization required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Core (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency and urgent care carry a $130 copay and no coinsurance, and worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Blue Cross Medicare Advantage Core (PPO) covers primary care physician services with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and podiatry require a $50 copay and no coinsurance, while mental health services have a $30 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Blue Cross Medicare Advantage Core (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and glaucoma screenings. While services like health education, memory fitness, and counseling are included, several supplemental benefits such as in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Core (PPO), offering routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay of $699 to $999, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Blue Cross Medicare Advantage Core (PPO) with no copay and no coinsurance, featuring up to two routine eye exams annually and a $150 yearly allowance for contacts and eyeglasses. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Core (PPO) provides partially covered dental services up to an annual limit of $1,000, featuring Medicare dental services for a $50 copay and no coinsurance, oral exams for a $10 copay and no coinsurance, and cleanings, x-rays, fluoride, periodontics, and adjunctive services for no copay and no coinsurance. Restorative services, endodontics, prosthodontics, implants, oral surgery, orthodontics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Core (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this plan, Medicare Part B insulin drugs are covered with a $0 to $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Blue Cross Medicare Advantage Core (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Core (PPO) partially covers medical equipment with no copay, though diabetic supplies are not covered. Covered items—including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts—require a coinsurance ranging from 20% to 35%.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Core (PPO) partially covers diagnostic and radiological services with prior authorization required, excluding lab services which are not covered. Diagnostic procedures and tests feature no coinsurance and a $0 to $50 copay, diagnostic radiological services have no copay, outpatient X-rays require a $25 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Blue Cross Medicare Advantage Core (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Core (PPO) partially covers Cardiac Rehabilitation Services with no coinsurance and copayments ranging from $25 to $30, though prior authorization is required. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Core (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Members pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Blue Cross Medicare Advantage Core (PPO), with Dual Eligible SNPs with Highly Integrated Services and other miscellaneous services not covered. Covered acupuncture requires a $15 copay and no coinsurance, while over-the-counter items and chronic illness meals are provided with no copay and no coinsurance.
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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